Telehealth Is About to Abruptly End for Seniors

In the early days of the COVID-19 pandemic, President Donald Trump and Congress put into place a program that allowed people on Medicare to get their health care over the Internet.

The policy proved wildly popular. Nearly half of Medicare beneficiaries received telehealth services in 2020 in an effort to keep their distance from hospitals and doctor’s offices during the pandemic.

But the program is set to expire Sept. 30 without Congressional action, which would leave millions of seniors suddenly unable to access the telehealth care that allowed them to avoid long drives and crowded waiting rooms. The program has been threatened before—Congress had to extend it in 2021, 2022, 2023, and in March 2025—but telehealth advocates say that they have little hope that the program will be saved in time for services to avoid disruption.

“People are going to go to sleep tonight having had telehealth coverage since the beginning of the pandemic—and most of them have used it one way or another,” said Kyle Zebley, the executive director of ATA Action, the advocacy arm of the American Telemedicine Association, on Sept. 30. “They will wake up in the morning not having that coverage.”

Two of those people are Dan and Doreen Nishimi, who are 82 and 78 respectively and who live in Elk Grove, Calif. Doreen, who had surgery for breast cancer last year, says she vastly prefers using telehealth to check in with her oncologist rather than driving the 27 miles round-trip to the office. And Dan, who has pulmonary hypertension and interstitial lung disease, says the video visits help save him from difficult trips to the doctor in which he needs to bring an oxygen tank and use a scooter. Traveling has gotten even more difficult in recent weeks after Doreen pinched a nerve in her spine and is now unable to lift Dan’s scooter.

“If you don’t have video visits, I would never see a doctor because I have such a hard time getting out of the house,” he says. He has a video visit scheduled with his primary care doctor next week.

Another program called acute hospital care at home, which allows convalescing patients to be discharged and receive monitored care at home, is also set to expire Sept. 30 without Congressional action. The Centers for Medicare & Medicaid Services has said that all patients must be discharged or returned to the hospital on Sept. 30.

Before the pandemic, it was extremely difficult for Medicare patients to qualify to get telehealth care. They had to live in a rural area classified a certain way, and they had to receive their telehealth services in a certain type of location—often a medical office. Congress passed waivers to those rules in the beginning of the pandemic, which are often referred to now as Medicare telehealth flexibilities.

Usage of telehealth through Medicare has declined since 2020, to about 25% of patients in 2024, according to the Centers for Medicare & Medicaid Services. But telehealth is still a lifeline for certain patients, including those who are immunocompromised or who live a long distance from their doctors’ office, says Mei Kwong, executive director of the Center for Connected Health Policy, a nonprofit that provides technical assistance to people with questions about telehealth policies.

What happens now?

Most mental-health telecare services under Medicare will continue after Sept. 30 because of a separate bill passed in 2021. But for other types of appointments, what will happen next is unclear.

Some providers may continue to offer telehealth to Medicare patients after Sept. 30, Kwong says. The telehealth flexibilities have been extended so many times in the past that many providers may assume they will be extended again, eventually—perhaps with retroactive payment for services rendered before Congress takes action. Smaller providers might not have the financial flexibility to do that, though. They may try to reschedule telehealth patients for a few weeks or months down the line, at which time they hope Congress will have acted.

Dr. James Marcin, director of the Center for Health and Technology at the University of California, Davis, who directs the system’s telehealth program, is urging administrators to continue business as usual and keep providing telehealth visits for Medicare patients, even though reimbursement is ending. It would be “disastrous” for many patients to have their visits rescheduled or to have to come to the doctor’s office in person and arrange for rides, childcare, and travel expenses, he says. UC Davis Health has 2,500 patients covered by Medicare scheduled for telehealth visits in October, he says.

Telehealth visits have been extremely helpful for patients who live many hours away, he says, and would otherwise have to come in for something quick like a medication check after surgery or a check-in on a chronic condition like arthritis. “We are thoughtful about these visits,” Marcin says. “If you need to come in and see someone, or have labs, you can, but we don’t want to force people to come in when it’s not necessary.”

Some providers, including Mass General Brigham Medical Group, expanded their telehealth capabilities in recent years as patients have embraced the option. In 2021, Mass General Brigham launched a virtual urgent care service that allows doctors to see patients in Massachusetts and New Hampshire via telehealth 365 days a year from 7 a.m. to 11 p.m., says Lindsay Gainer, president and chief operating officer of the Mass General Brigham Medical Group. That’s allowed doctors to help patients resolve complaints or be seen quickly and bypass expensive emergency room visits.

Doctors are also able to see patients virtually to deal with chronic disease management, Gainer says. Even though the practice gets compensated at a slightly lower rate for telehealth, virtual visits save money overall, she says, because doctors don’t need the office infrastructure and personnel that they might need if they were seeing someone in-person. Like UC-Davis, Mass General Brigham plans to keep offering telehealth to Medicare patients in the hope that Congress will resolve the issue quickly.

The need for a telehealth solution

Even if Congress does eventually extend the telehealth flexibilities, there’s a need for a longer-term solution making telehealth under Medicare more permanent, says Sarah Hohman, director of government affairs at the National Association of Rural Health Clinics. For one thing, it is stressful for providers to keep nearing a cliff after which they won’t be compensated for providing telehealth to Medicare patients. For another, under current law, rural health clinics can only bill a very low amount for telehealth visits: $94.45, no matter what the visit is for.

This has forced rural health clinics to operate without adequate reimbursement since 2020, Hohman says. “If a facility is getting significantly less through telehealth, it’s a lot harder for them to invest in what are often very expensive technologies,” she says.

Telehealth advocates worry that if the flexibilities are allowed to expire, private insurers may follow suit and stop offering coverage of telehealth services. “As Medicare goes, so goes the nation,” says Zebley, of ATA.

To many advocates, the failure of Congress to extend the Medicare telehealth flexibilities points to a large problem of how Congress has started to operate in recent years. Both the telehealth flexibilities and the acute hospital at-home care “should have been made permanent in a normal world of DC operating like it should,” says Zebley.

But Congress is less prone to doing standalone pieces of legislation anymore and instead keeps passing “extenders,” he says, which essentially kick the can down the road. (Enhanced premium tax credits, which made health plans through the Affordable Care Act much more affordable, are also set to end soon because a Congressional extender is expiring.)

Of course, even if Congress had acted, it might not have given telehealth advocates the breathing room they wanted. Proposed Democratic and Republican plans—none of which passed—would have extended the telehealth flexibilities a few months at most, he says—until October or November.

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